Provider Demographics
NPI:1861676157
Name:DISTINCTIVE HOME CARE, LLC
Entity Type:Organization
Organization Name:DISTINCTIVE HOME CARE, LLC
Other - Org Name:DISTINCTIVE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-727-9142
Mailing Address - Street 1:33920 US HIGHWAY 19 N
Mailing Address - Street 2:SUITE 341
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-2654
Mailing Address - Country:US
Mailing Address - Phone:727-786-5520
Mailing Address - Fax:727-787-6893
Practice Address - Street 1:6460 NW 5TH WAY
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-6112
Practice Address - Country:US
Practice Address - Phone:954-727-9142
Practice Address - Fax:954-727-2825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211309311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30211309OtherPRIVATE DUTY/NURSE REGIST